CHART Model Fact Sheet

 

From the CMS, Through the Community Health Access and Rural Transformation (CHART) Model, CMS aims to continue addressing disparities by providing a way for rural communities to transform their health care delivery systems by leveraging innovative financial arrangements as well as operational and regulatory flexibilities.

The approximately 57 million Americans living in rural communities, including millions of Medicare and Medicaid beneficiaries, face unique challenges when seeking healthcare services, such as limited transportation options, shortages of health care services, and an inability to fully benefit from technological and care-delivery innovations. These challenges result in rural Americans facing worse health outcomes and higher rates of preventable diseases than those living in urban areas.

Community Transformation Track

CMS will select up to 15 Lead Organizations for this track. A Lead Organization is a single entity that represents a rural Community, comprised of either (a) a single county or census tract or (b) a set of contiguous or non-contiguous counties or census tracts. Each county or census tract must be classified as rural, as defined by the Federal Office of Rural Health Policy’s list of eligible counties and census tracts used for its grant programs.1 Examples of entities eligible to serve as Lead Organizations include, but are not limited to, state Medicaid agencies, State Offices of Rural Health, local public health departments, Independent Practice Associations, and Academic Medical Centers.

Lead Organizations will be responsible for working closely with key model participants (e.g., including Participant Hospitals and the state Medicaid agency) and driving health care delivery system redesign by leading the development and implementation of Transformation Plans with their community partners. The Transformation Plan is a detailed description that outlines the community’s plan to implement health care delivery redesign strategy.

Lead Organizations and their community partners will receive upfront cooperative agreement funding, financial flexibilities through a predictable capitated payment amount (CPA) for Participant Hospitals in a community, and operational and regulatory flexibilities.

The 15 Community Lead Organizations are critical to the success of the Model because they will coordinate efforts across the community to ensure that access to care is maintained and that the needs of various stakeholders are understood and accounted for in the transformation plan. Lead Organizations are responsible for managing cooperative agreement funding, recruiting Participant Hospitals, engaging the state Medicaid agency, establishing relationships with other aligned payers, convening the Advisory Council, and ensuring compliance with Model requirements. Ultimately, the Lead Organization will oversee the execution and coordination of a Transformation Plan that outlines the health care delivery redesign strategy for the Community.

CO Transformation Track

CMS will select up to 20 rural-focused ACOs to receive advanced payments as part of joining the Medicare Shared Savings Program (Shared Savings Program). Building on the success of the ACO Investment Model (AIM), the advanced shared savings payments are expected to help CHART ACOs engage in value-based payment efforts that will improve outcomes and quality of care for rural beneficiaries.  A majority of ACO providers/suppliers of the CHART ACO must be located within rural counties or census tracts as defined by FORHP.

CMS will offer CHART ACOs advanced shared savings payments comprised of two components:

• A CHART ACO will be able to receive a one-time upfront payment equal to a minimum of $200,000 plus $36 per beneficiary to participate in the 5-year agreement period in the Shared Savings Program.
• A CHART ACO will be able to receive a prospective per beneficiary per month (PBPM) payment equal to a minimum of $8 for up to 24 months.

The amount for the upfront payment and the PBPM will vary based on the level of risk that the CHART ACO accepts in the Shared Savings Program and the number of rural beneficiaries assigned to it based on the Shared Savings Program assignment methodology, up to a maximum of 10,000 beneficiaries.

The CHART ACO will enter into participation agreements with CMS to participate in both the Shared Savings Program and the CHART Model and, for the full duration of the agreement period, meet the requirement that a majority of its ACO providers and suppliers are located within rural counties or census tracts.

Timeline

CMS anticipates the Notice of Funding Opportunity (NOFO) for the Community Transformation Track will be available in September on the Model website. The Request for Application (RFA) for the ACO Transformation Track will be available in early 2021.

The forthcoming NOFO and RFA will contain detailed information to assist interested applicants.

Additional Information

• Fact Sheet
• Press Release
• Webinar: Community Health Access and Rural Transformation (CHART) Model – Overview

Dear all –

Here is the updated Advanced RHC Billing presentation that I gave at NARHC this week.  I updated claim examples and added some explanation on service detail billing.  I thought my comments on billing full charge amounts vs using the “$.01” method needed a bit more clarification.  Let me know if you have any questions –

Charles

Advanced RHC Billing v.2019 Updated

CMS Final Rule for RHCs and FQHCs!  Policy and Procedure Review, Annual Evaluation, and Emergency Preparedness requirements have been changed.

Document Number:  2019-20736 “Medicare and Medicaid Programs: Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction; Fire Safety Requirements for Certain Dialysis Facilities; Hospital and Critical Access Hospital Changes to Promote Innovation, Flexibility, and Improvement in Patient Care. ”

The new final rule does the following:

• changes the Policy Review and Annual Evaluations to biennial requirements.
• changes the requirement for facilities to review their emergency preparedness program to at least biennial.
• eliminates the need to document outreach efforts to local emergency resources, but facilities will “still be required to include a process for cooperation and collaboration” with them.
• requires facilities to provide training biennially or every 2 years, after facilities conduct initial training on their emergency program.
• requires that providers of outpatient services conduct only one testing exercise per year, that either a community-based full-scale exercise (if available) or conduct an individual facility-based functional exercise every other year.
• In the opposite years, these providers may conduct the testing exercise of their choice, which may include either a community-based full-scale exercise (if available), an individual, facility-based functional exercise, a drill, or a tabletop exercise or workshop that includes a group discussion led by a facilitator.
• if a provider experiences an actual natural or man-made emergency that requires activation of their emergency plan, inpatient and outpatient providers will be exempt from their next required full-scale community-based exercise or individual, facility-based functional exercise following the onset of the actual event.

https://www.federalregister.gov/documents/2019/09/30/2019-20736/medicare-and-medicaid-programs-regulatory-provisions-to-promote-program-efficiency-transparency-and

The following are now biennial, not annual requirements:

Review of Patient Care Policies §491.9(b)(4)

RHC and FQHC Program Evaluation – §491.11(a)

Annual Review of Emergency Preparedness Program – §491.12

Annual Emergency Preparedness Training Program §491.12(d)(1)(ii)

The requirements for the following have been eased:

Documentation of Cooperation Efforts – §491.12(a)(4) has been eliminated

Annual Emergency Preparedness Testing – §491.12(d)(2) – only one required per year

 

Let us know if you have any questions!

Charles

“As emergencies rise across rural America, a hospital fights for its life”

https://www.washingtonpost.com/news/national/wp/2019/05/11/feature/whos-going-to-take-care-of-these-people/?utm_term=.667991f96042